A provider network is a group of doctors, hospitals, and healthcare workers who are joined in a group to offer medical services to patients. A provider network typically falls into one of two categories including an HMO and a PPO. Networks typically have a variety of resources where patients of particular healthcare plans may go to receive care that is covered by their insurance policy. In general, a patient must obtain medical treatment from one of the providers in their designated network in order for the insurance to pay the costs.
HMO and PPO
A Health Maintenance Organization (HMO) is a network of care providers. If you choose an HMO health plan you will designate a primary care physician. Your primary care doctor will be your first visit for any services excluding emergency care. Your doctor will diagnose and treat you and if you require a specialist, your doctor will provide a referral. Without a referral, specialist treatment is not covered by insurance and you could end up paying the full costs for care.
A Preferred Provider Organization (PPO) is another type of provider network. A PPO plan often allows you to seek medical care outside the network and you don’t need a referral to see a specialist. A PPO plan is generally more expensive than an HMO because you get more choices for treatment. It is essential to understand the differences before you choose a healthcare plan.
In and Out of Network Providers
When you sign up for a health insurance policy you will choose your primary doctor from a list of available physicians in the network. Treatment and services you obtain in-network are usually covered by your insurance policy based on the specific details of the plan. An out-of-network provider is a doctor or other care provider who is not in your plan’s network. If you visit a doctor outside of your network you may encounter costs that are not covered by your insurance policy. This will make your care more expensive as you pay for medical bills out-of-pocket.
What to Expect with a Provider Network
Provider networks are designed to provide the best possible medical care at reasonable prices to the insurance company and ultimately to the patient. When you sign up for a healthcare plan, review the doctors who are available for primary care. You can often find a list of doctors on your insurance company’s website or by calling your insurance provider. When you are in need of medical care, ensure that you choose a doctor in your provider network. Review your policy to determine whether copayment costs are necessary when you visit a particular medical facility. You will have a copayment that is due when you receive medical care. You will also have a deductible that accrues throughout the year. It is almost always best to visit a doctor within your provider network. If you already have a primary physician, check to see whether the doctor is part of the provider
network for the healthcare plan you choose.
For help choosing a healthcare plan, visit Fast Health Quotes online or call us at (855) 244-9579.